Additional Resources

STATE | Out of Network Billing Advocacy Update

Thursday, February 23, 2017

Last year, ASPS's Legislative Advocacy Committee developed, and the Executive Committee approved, a Position Statement on Out of Network Billing. "Surprise" billing legislation typically applies to out of network emergency services and also can apply to out of network services provided at a facility that is otherwise in an insurer's network. (For additional information on this issue, please review ASPS's Position Statement on Out of Network Billing and related issue brief). Since the statement was finalized, ASPS has been teaming with state plastic surgery society partners and medical societies to weigh-in on this issue nationwide.

In California, ASPS and the California Society of Plastic Surgeons opposed legislation that ultimately set reimbursement for out of network services provided at an in network facility at the greater of the average contracted rate or 125% of Medicare.

In Georgia, ASPS is requesting that out of network billing legislation currently under consideration be amended to use Fair Health, Inc. to set rates for out of network services provided at an in-network facility. Fair Health, Inc. is a non-profit that has the nation's largest collection of privately billed medical claims data.

After advocacy efforts conducted by ASPS and the Idaho Medical Association, proposed out of network billing and network adequacy regulations are being redrafted to achieve greater consensus with the physician community.

ASPS worked with the New Hampshire Medical Association and opposed out of network billing legislation that would not permit patients to privately contract with out of network providers at in network facilities. This legislation is set for further study by the legislature.

ASPS works closely with the New Jersey Society of Plastic Surgeons (NJSPS) in opposition to out of network billing legislation that would use a percentage of the Medicare rate to settle disputes regarding reimbursement for out of network care provided inadvertently or in an emergency by paying. ASPS and NJSPS launched a successful grassroots campaign which yielded 187 letters sent from New Jersey plastic surgeons. The committee considering the bill is holding it until further notice.

ASPS also recently submitted comments in Oregon and Washington requesting that introduced out of network billing legislation be amended to conform to ASPS's positions on the issue.

Additionally, ASPS is working with the Massachusetts Medical Society on upcoming surprise billing legislation.

ASPS will continue to engage on this issue as it is considered nationwide. It is essential that enacted legislation fix the actual problems that cause surprise billing, namely inadequate and non-transparent insurance products and uninformed patients. Legislative remedies shouldn't try to patch the problems by setting out of network rates artificially low.